What is a migraine? Why migraine happens. Who gets migraines? Treating migraines.

That Time of Month

Sixty percent of women with migraines report attacks that coincide with various points of their menstrual cycle. Such attacks are called menstrually-related migraines or MRMs. The medical community considers any attack that occurs within the two days prior to and up to two days after menstruation as MRMs.

Uncommon Condition

While many women have premenstrual migraines during the week prior to menstruation, a small number of women have migraine attacks from the day before up to the first four days of their menstrual periods. This condition is uncommon, occurring in about 14% of women. Women with a tendency to menstrual migraines never have migraines at any other time.

Keep a Calendar

A calendar or headache journal can be a great help in confirming an association between the menses and migraine headaches. Painful periods are associated with menstrual migraine while premenstrual attacks may be accompanied by other symptoms of premenstrual dysphoric disorder (PMDD) including backache, breast tenderness and swelling, mood changes, and nausea.

While there has long lingered an impression that menstrual migraines are more severe and harder to treat, it appears there is no significant difference in how these attacks respond to the migraine drugs known as triptans. This suggests that it is only the ability to predict attacks that makes menstrual migraines unique.

When standard preventive medicine fails to manage MRMs, hormonal therapy may be indicated. Supplemental estrogen by mouth or in the form of a transdermal patch may be used 2 days before menstruation and throughout the menstrual period. Estradiol is the preferred form of estrogen for this treatment.

Women on the pill for contraceptive purposes should start supplemental estrogen on the last day of the pill pack. There is another treatment option in which women who take a combined estrogen and progesterone oral contraceptive take it every day, with no break for from 3-6 months. This preventive therapy for migraine is safe even when used for up to a year. In this therapy, blocking menstruation prevents the associated MRMs.

A woman with hormone-related headache presents specific challenges to clinicians. In the case of women past childbearing age, estrogen compounds as treatment for migraines may tend to be an actual cause of migraines, instead. Better results are obtained with estradiol than with other forms of estrogen since estradiol doesn't convert to other active forms of estrogen. Hysterectomy and oophorectomy are not considered effective preventive treatment for hormone-related migraine attacks and may even increase the incidence of migraine attacks.

Females who suffer from migraine with aura should use the lowest effective dose of estrogen since there is an associated risk of stroke.